Healthcare Provider Details

I. General information

NPI: 1285609024
Provider Name (Legal Business Name): SATYANARAYAN AVULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 RICHMOND AVE
STATEN ISLAND NY
10314-1562
US

IV. Provider business mailing address

1285 RICHMOND AVE
STATEN ISLAND NY
10314-1562
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3020
  • Fax: 718-494-3566
Mailing address:
  • Phone: 718-370-3020
  • Fax: 718-494-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number131633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: